OBJECTIVE: Linkage to HIV medical care is important in the continuum of HIV care and health outcomes for people with HIV. The objective of this analysis was to identify how the community-based organization (CBO) program contributes to linkage to HIV medical care among people with newly diagnosed HIV in the Centers for Disease Control and Prevention's (CDC's) HIV testing program. METHODS: We analyzed HIV linkage-to-care data submitted to CDC from 2019 through 2021. Linkage was defined as confirmation that an individual attended their first HIV medical care appointment within 30 days of their HIV test date. We included in the analysis data submitted from the health department (HD) program that included 61 state and local HDs in the United States, Puerto Rico, and the US Virgin Islands and the CBO program that included 150 CBOs. RESULTS: The CBO program linked a higher proportion of people to HIV medical care within 30 days of diagnosis (86.7%) than the HD program (73.7%). By population group, the proportion linked in the CBO program was higher than the proportion linked in the HD program among men who have sex with men (prevalence ratio [PR] = 1.13; P < .001), men who have sex with men/people who inject drugs (PR = 1.29; P < .001), transgender people (PR = 1.28; P < .001), and those reporting no sexual contact or injection drug use (PR = 1.34; P < .001). In the Cox proportional hazards model, time to linkage in the CBO program was significantly shorter than in the HD program (hazard ratio = 0.63; P < .001). CONCLUSION: This analysis shows that the CBO program fills a vital need in linking newly diagnosed HIV-positive people to HIV medical care, which is important in the HIV care continuum and for viral suppression.

BACKGROUND: Medicaid is the single largest source of health care coverage for people living with HIV (PLWH) in the United States. Therefore, high-quality HIV care and associated viral suppression among Medicaid beneficiaries have the potential to greatly impact the HIV epidemic. The HIV Health Improvement Affinity Group (HHIAG) supported state efforts to improve health outcomes for PLWH enrolled in Medicaid through new or enhanced collaborations between state public health departments and state Medicaid agencies. METHODS: Supported by multiple federal health agencies for 1 year, state health department and Medicaid staff from 19 states participated in state-to-state learning and sharing of promising approaches. This evaluation assessed the HHIAG's processes, short-term outcomes, and lessons learned through review of state materials, a web survey, and telephone interviews. RESULTS: Of the 19 states, 13 (68%) ultimately established new, or refined existing, data-sharing agreements between Medicaid and public health departments. Nearly all states with data-sharing agreements successfully matched the data or streamlined the data-matching process (n = 12/13). Two-thirds of states (67%, n = 8/12) with matched data generated an HIV care continuum for state Medicaid/Children's Health Insurance Program beneficiaries; 75% (n = 6/8) of these states also initiated quality improvement activities. CONCLUSIONS: The HHIAG created an unique opportunity for multiple federal agencies and states to collaborate and implement data-driven, state-specific solutions to improve care delivery and, ultimately, clinical outcomes for PLWH. The HHIAG model has the potential to be replicated to address other public health issues that cross agency and institutional boundaries, such as hepatitis C.

Community-based organizations (CBOs) provide HIV prevention services throughout the United States, including the South where HIV/AIDS burden is high. We assessed Southern CBO response to changes in the HIV prevention landscape, including the National HIV/AIDS Strategy, and the Centers for Disease Control and Prevention's (CDC's) High Impact Prevention. Both strategies aim to improve outcomes for people living with or at high risk for HIV. Inductive qualitative analysis of interviews and consultations with CBOs, capacity building assistance providers, and CDC staff revealed CBOs are building clinical service capacity and cross-agency partnerships to adapt, but face inadequate or reduced funding. A holistic approach to HIV prevention and care in the South is critical, where stigma and other socio-structural factors limit health care options for persons affected by HIV. Health care organizations may benefit by partnering with CBOs because CBOs have the skillsets and community rapport to effectively improve health outcomes of persons living with HIV.

OBJECTIVE: HIV prevention has changed substantially in recent years due to changes in national priorities, biomedical advances, and health care reform. Starting in 2010, motivated by the National HIV/AIDS Strategy (NHAS) and the Centers for Disease Control and Prevention's (CDC's) High-Impact Prevention (HIP), health departments realigned resources so that cost-effective, evidence-based interventions were targeted to groups at risk in areas most affected by HIV. This analysis describes how health departments in diverse settings were affected by NHAS and HIP. METHODS: We conducted interviews and a consultation with health departments from 16 jurisdictions and interviewed CDC project officers who monitored programs in 5 of the jurisdictions. Participants were asked to describe changes since NHAS and HIP and how they adapted. We used inductive qualitative analysis to identify themes of change. RESULTS: Health departments improved their HIV prevention practices in different ways. They aligned jurisdictional plans with NHAS and HIP goals, increased local data use to monitor program performance, streamlined services, and strengthened partnerships to increase service delivery to persons at highest risk for infection/transmission. They shifted efforts to focus more on the needs of people with diagnosed HIV infection, increased HIV testing and routine HIV screening in clinical settings, raised provider and community awareness about preexposure prophylaxis, and used nontraditional strategies to successfully engage out-of-care people with diagnosed HIV infection. However, staff-, provider-, and data-related barriers that could slow scale-up of priority programs were consistently reported by participants, potentially impeding the ability to meet national goals. CONCLUSION: Findings suggest progress toward NHAS and HIP goals has been made in some jurisdictions but highlight the need to monitor prevention programs in different contexts to identify areas for improvement and increase the likelihood of national success. Health departments and federal funders alike can benefit from the routine sharing of successes and challenges associated with local policy implementation, considering effects on the overall portfolio of programs.

In 2006, the Centers for Disease Control and Prevention (CDC) funded community-based organizations (CBOs) to deliver Many Men, Many Voices (3MV) to young men of color who have sex with men. Although 3MV, a group-level behavioral intervention designed to reduce human immunodeficiency virus (HIV) risk behaviors of black men who have sex with men (MSM), has shown effectiveness when delivered in a controlled research environment, there is limited evidence that the intervention is associated with similar outcomes in "real world" settings. For the current project, CDC funded three CBOs to conduct outcome monitoring of the 3MV intervention to determine if young MSM of color report changes in HIV risk behaviors postintervention. Using a repeated measures design, risk behaviors were collected at baseline and again at 3 and 6 months postintervention. Changes in risk behaviors were assessed using generalized estimating equations. Participants (n = 337) reported decreases in sexual risk behaviors at both follow-up time points, such as sex without a condom, sex without a condom and multiple partners, and sex without a condom with serodiscordant or status unknown partners. Results suggest that 3MV may be an effective tool for reducing HIV risk behaviors in this critical target population.

There is limited knowledge about whether the delivery of evidence-based, HIV prevention interventions in 'real world' settings will produce outcomes similar to efficacy trial outcomes. In this study, we describe longitudinal changes in sexual risk outcomes among African American and Hispanic participants in the Video Opportunities for Innovative Condom Education and Safer Sex (VOICES/VOCES) program at four CDC-funded agencies. VOICES/VOCES was delivered to 922 high-risk individuals in a variety of community settings such as substance abuse treatment centers, housing complex centers, private residences, shelters, clinics, and colleges. Significant risk reductions were consistently observed at 30- and 120-days post-intervention for all outcome measures (e.g., unprotected sex, self-reported STD infection). Risk reductions were strongest for African American participants, although Hispanic participants also reported reducing their risky behaviors. These results suggest that, over a decade after the first diffusion of VOICES/VOCES across the U.S. by CDC, this intervention remains an effective tool for reducing HIV risk behaviors among high-risk African American and Hispanic individuals.